The author ts extremely grateful to all the contributors for high standard of the new chapters, and hopes that you, reader, will enjoy going through these pages as much as

 

The author ts extremely grateful to all the contributors for

high standard of the new chapters, and hopes that you,

reader, will enjoy going through these pages as much as

had.

M. El-Mutury

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Surgical Anatorry)

First Edition

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The Head and neck anatomy is

a

challenge because the region is packed

with small, important structures.

These structures are associated with

the proximal ends of the respiratory

and gastrointestinal systems,, the

cranial nerves, and the organs of

special sense, all of which are found

within the region. Dissection of the

head and neck provides a special

problem in that peripheral structures

must be dissected long before their

parent structure can be identified. I

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The iuqular foramen transmits:

- lnternaljugularvein.

- lnferior petrosal sinus.

- Glosso-pharyngeal, vagus and accessory nerves (lX, X, XI).

A tumor invading iugular foramen mav lead to:

- Loss of taste sensation from posterior Ts of tongue.

- Increased intra-cranial pressure.

- Paralysis of muscles of soft palate.

HEAD & NECK T

It is the soft tissue covering the

skull vault.

# Structure: ihyers:

t. Skin: rich in hair follicles &

sebaceous glands.

2. Elonnective tissue (dense & fatty):

o Blood vessels are located

primarily in this layer.

o When injecting local anesthetic,

the tip of the needle should be

inserted in this layer.

3. Aponeurosis: flat membrane.

4. Eoose areolar connective tissue

(the dangerous area of the scalp):

allowing free mobility of the 1't 3

layers on the underlying A"gporomrrvm

periosteum.

5. Eeriosteum (peri-cranium):

. Loosely attached to the bones, but firmly attached to suture lines.

. Continuous with the outer layer of dura at the foramen magnum.

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This is the loose areolar C.T. layer.

It contains emissary veins

- which connect scalp veins to the dural sinuses.

Muscles of the scalp:

- Occipitalis is

#

attached to the skull (at superior nuchal line).

- Frontalis is not attached to the skull.

- The muscles of the scalp are innervated by the facial nerve.

Lymphatic Drainage Of The Scalp: *

- To the superficial circle of LNs around lower part of skull ) deep LNs around

carotid sheath.

Blood & sensorv nerve supplv of the scalo:

l.Supratrochlear n.

2.Supra-orbital n.

3.Zy gomaticotempo ral n.

4.Auriclotemporal n.

Branches of ophthalmic a. of the

I.C.A:

S upra-troch lear artery.

Supra-orbital artery.

Branches of E.C.A:

Suoerficial temooral arte

l.Great auricular n.

2.Lesser occipital n.

3.Greater occipital n.

4.3rd occipital n.

Branches of E.C.A:

Posterior auricular artery.

Occipital artery.

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Venous drainage:

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) unit to form faciat vein at the mediat orbitat marsin

3- Superficial temporal vein

4- Maxillary vein

5- Occipital vein

Points of Suroical Importance:

E The 1st three lavers of the scalp are intimatelv united & should be consjdered as

one laver

. Comprise the superficial 3 layers.

o They are turned downwards & not upwards (nerves & vesse/s enter the

scalp from periphery).

. Subcutaneous hematoma is small, tense & painful.

. Sub-aponeurotic collection of blood: may extend anteriorly to the

eyelids forming black eye & posteriorly to superior nuchal line

(attach ment of occipito-frontalis).

. Sub-periosteal collection of blood:

- ls limited by attachment of the periosteum to the suture lines.

- Feels like depressed fracture due to fibrin deposition at its

periphery.

! nrnn a NECK

tr The scalp has very rich blood supplv. this explains:

. Wounds of scalp bleed profusely. Bleeding can be stopped by compressing the

scalp over the underlying skull bone.

. Wounds heal well; minimal debridement is required & wound infection is

uncommon.

There is no subcutaneous fat in scalp ) no lipoma.

Plentiful sebaceous qlands make the scalp one of the most common sites for

sebaceous cysts.

Emissary veins do not have valves and open in the loose areolar tissue;

therefore, infection can be transmitted from the scalp to the cranial cavity. The layer of

loose areolar tissue is known as the dangerous area of the scalp.

Metastatic spread of maliqnant lesions in front of the auricle is to the parotid and

cervical groups of lymph nodes. The posterior part of the scalp is drained to the

occipital and posterior auricular groups of lymph nodes.

tr Anastomosis exists at the medial anqle of the eve. between the facial branch of

the external carotid arterv and the cutaneous branch of the internal carotid

arterv. During old age, if the internal carotid artery undergoes atherosclerotic changes,

the intracranial structures can receive blood from the connection of the facial artery to

the dorsal nasal branch of the ophthalmic artery.

Y?*- '

Each side of the neck is divided into anterior & posterior triangles by the sternomastoid

muscle

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HEAD & NECK I

2-

3-

Roof :

1-

2-